By: Christopher A. Parrella, Esq., CPC, CHC, CPCO Parrella Health Law, Boston, Ma.
A Health Law Defense and Compliance Firm
In a significant case that underscores the risks of fraudulent billing practices, a former co-owner of a St. Louis healthcare company has been sentenced for his role in a $3.8 million fraudulent billing scheme. Carlos Himpler, 44, was sentenced to 20 months in prison and fined $100,000 after pleading guilty to submitting false claims to Medicare, Medicaid, and private insurers.
Himpler, along with his co-defendant Dr. Franco Sicuro, engaged in a complex scheme that involved the creation of two laboratories—Advanced Geriatric Management LLC (AGM) and Genotec DX—both operating out of the same location and using the same equipment. To secure accreditation and bill insurers, the pair made false representations about the operations of these labs, hiding the fact that they were essentially one and the same.
The Fraudulent Scheme
The activities centered around the practice of “pass-through billing,” a method where services are billed under a provider’s name even though they were performed by another entity. In this case, AGM and Genotec referred urine toxicology tests to outside laboratories and then billed Medicare, Medicaid, and private insurers for these tests as if they had performed them in-house. This practice is prohibited under most insurance guidelines, which require that the entity performing the service must be the one to bill for it. When insurers began to question the legitimacy of these claims, Himpler and Sicuro established a third entity, Midwest Toxicology Group LLC, which was a lab in name only. This new entity lacked the necessary certifications and equipment to perform the tests but was used to continue the fraudulent billing practices. The result was a $3.8 million scam that ultimately led to significant financial losses for federal and private health programs.
The Consequences
The consequences for Himpler and Sicuro were severe. Himpler has been sentenced to prison and fined, while Dr. Sicuro, who pleaded guilty earlier, agreed to forfeit $3.1 million in assets. This case serves as a stark reminder that pass-through billing and other fraudulent billing practices can lead to significant legal repercussions, including imprisonment, hefty fines, and forfeiture of assets.
The case of Carlos Himpler and Dr. Franco Sicuro illustrates the dangers and legal risks associated with pass-through billing. Healthcare providers must ensure that their billing practices comply with all relevant regulations to avoid severe penalties. If you have any questions or concerns about your billing practices and compliance, please contact Parrella Health Law at 857.328.0382 or Chris directly at cparrella@parrellahealthlaw.com. Our team is here to help navigate the complexities of healthcare law and ensure that your practice remains compliant.
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